Provider First Line Business Practice Location Address:
1404 S LAFAYETTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28152-6658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-484-3390
Provider Business Practice Location Address Fax Number:
980-842-0212
Provider Enumeration Date:
08/12/2024